Part 1.
TEXAS DEPARTMENT OF HUMAN SERVICES
Chapter 51.
WAIVER PROGRAM FOR MEDICALLY DEPENDENT CHILDREN
The Texas Department of Human Services (DHS) proposes amendments to §51.1,
concerning purpose, §51.2, concerning definitions, §51.3, concerning
participant eligibility criteria, §51.4, concerning location of medically
dependent children program (MDCP) waiver service delivery, §51.5, concerning
waiver services, §51.7, concerning cost controls and cost savings, and §51.31,
concerning deinstitutionalization due to closure of facility, and the repeal
of §51.6, concerning provider base and reimbursement methodology, in
its Waiver Program for Medically Dependent Children chapter. The purpose of
the amendments and the repeal is to complete the transfer of Chapter 51 from
the Texas Department of Health (TDH) to DHS by correcting references within
the rule. The proposal also repeals §51.6 and places all material not
directly related to rate analysis and determination in appropriate areas of
the chapter. The Texas Health and Human Services Commission (HHSC) will assume
responsibility for rate analysis and determination.
James R. Hine, Commissioner, has determined that for the first five-year
period the proposed sections will be in effect there will be no fiscal implications
for state and local government as a result of enforcing or administering the
sections.
Mr. Hine also has determined that for each year of the first five years
the sections are in effect the public benefit anticipated as a result of adoption
of the proposed rules will be to eliminate outdated references within the
rule and to repeal the section that deals with reimbursement rates. There
will be no effect on small or micro businesses as a result of enforcing or
administering the sections because the changes are technical in nature. There
is also no probable effect on local employment in geographic areas affected
by these sections.
Questions about the content of this proposal may be directed to Lori Roberts
at (512) 438- 5391 in DHS's Long Term Care/Community Care Program. Written
comments on the proposal may be submitted to Supervisor, Rules and Handbooks
Unit-156, Texas Department of Human Services E-205, P.O. Box 149030, Austin,
Texas 78714-9030, within 30 days of publication in the
Texas Register
.
Under §2007.003(b) of the Texas Government Code, the department has
determined that Chapter 2007 of the Government Code does not apply to these
rules. Accordingly, the department is not required to complete a takings impact
assessment regarding these rules.
40 TAC §§51.1 - 51.5, 51.7, 51.31
The amendments are proposed under the Human Resources Code,
Title 2, Chapters 22 and 32, which authorizes the department to administer
public and medical assistance programs; and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assistance funds.
The amendments implement the Human Resources Code, §§22.001-22.030
and §§32.001-32.042.
§51.1.Purpose.
This chapter implements the Medically Dependent Children Program (MDCP),
a statewide Medicaid waiver program
that serves
[
§51.2.Definitions.
The following words and terms, when used in this chapter, [
(1)
Adaptive aid--A device necessary to treat, rehabilitate,
prevent, or compensate for conditions
that result
[
(2)
(No change.)
(3)
Applicant--An individual whose eligibility for waiver services
is in the process of being determined. An individual becomes an applicant
when
he
[
(4)
Basic child care--Watchful attention and supervision by
a designated provider in the absence of the primary caregiver during those
hours when the caregiver is at work, in
job training
[
(5)-(6)
(No change.)
(7)
Care planning process--A collaborative activity, subject
to established time frames
that
[
(8)
Centers for Medicare &
Medicaid Services (CMS)--An organizational division of the U.S. Department
of Health and Human Services that is responsible for approval, monitoring,
and oversight of state Medicaid programs.
(9)
[
(10)
[
(11)
[
(12)
[
[
(13)
Individual
Plan of Care
[
(14)
Interest list--A statewide
listing of individual ordered on a first-come, first- served basis who have
indicated their interest in participating in the MDCP through submission of
the MDCP Interest List Information Form. Inclusion on the interest list does
not imply eligibility for MDCP.
(15)
[
(16)
[
(17)
[
(18)
[
(19)
[
(20)
[
(21)
[
(22)
[
(23)
[
[
(24)
Waiver--An exception to otherwise applicable requirements.
A waiver approved by
CMS
[
§51.3.Participant Eligibility Criteria.
(a)
(No change.)
(b)
Participant eligibility. To be a participant of the MDCP,
an individual must:
(1)-(5)
(No change.)
(6)
have a physician's signed approval
that attests
[
(7)
have an IPC
that
[
(8)
have an approved IPC for which the projected annual cost
for waiver services does not exceed the established annual waiver service
cost allowance. The allocation for
direct- care
[
(A)
Category A.
DHS
[
(B)
Category B.
DHS
[
(i)-(iii)
(No change.)
(iv)
the participant has a severe immunological disorder or
a similar medical condition
that
[
(9)
meet the following requirements:
(A)
(No change.)
(B)
the applicant or participant must meet SSI disability criteria
and must:
(i)
(No change.)
(ii)
be an individual under 19 years of age for whom the Texas
Department of Protective and Regulatory Services (PRS) assumes financial responsibility,
in whole or in part (not to exceed Level II
foster-care
[
(I)
a family foster home
that
[
(II)
a family foster home
that
[
(iii)
be a member of a family
that
[
(iv)
(No change.)
(c)-(d)
(No change.)
(e)
Interest
[
(1)
the
Interest List Information Form
[
(2)
the family or the registrant requests that the registrant's
name be removed from the
interest
[
(f)
(No change.)
(g)
Application deadline. If a registrant fails to complete
and return all required application materials within 35 calendar days from
the date of the application transmittal letter, the registrant's potential
application
is
[
(h)
Eligibility denial and exceptions. Unless an exception
is made following a review of special circumstances, waiver eligibility
is
[
(1)
waiver services are not
used
[
(A)-(D)
(No change.)
(2)
the
applicant's/participant's
[
(3)
the
applicant's/participant's
[
(4)
the
applicant's/participant's
[
(5)
(No change.)
(i)
(No change.)
§51.4.Location of Medically Dependent Children Program (MDCP) Waiver Service Delivery.
MDCP waiver services may not be provided:
(1)
(No change.)
(2)
in institutional settings, except as specified in
§51.5(b)(1)
[
(3)
(No change.)
§51.5.Waiver Services.
(a)
Relationship of waiver services to other sources of caregiving
and support.
(1)
Individual
Plans of Care
[
(2)-(3)
(No change.)
(4)
Waiver services
are
[
(5)
Parents/caregivers
are
[
(A)
The cost of basic child care
is
[
(i)
(No change.)
(ii)
recognized and accepted community-based child care data
analyses,
for example
[
(B)
The total parental contribution to child care includes
the cost of basic child care and may be affected by:
(i)
the participant's eligibility for programs such as Head
Start or [
(ii)
(No change.)
(b)
Waiver service array. In addition to Medicaid state plan
services, the following services are available to a waiver participant when
included in the participant's IPC and when unavailable from other sources:
(1)
Respite services. Respite services may be provided by licensed
registered nurses (RNs); eligible licensed vocational nurses (LVNs); licensed
home and community support services agencies (HCSSAs)
that
[
(2)
Adjunct supports. Adjunct supports may be provided either
by the MDCP or by sources outside the MDCP waiver, and they may be provided
on a one-time basis, on an ongoing basis, intermittently, or as the participant's
condition, child care arrangements, or living arrangements change. To support
participation in child care, adjunct supports
are
[
(A)-(B)
(No change.)
(C)
limited modifications to an out-of-home, more inclusive
child care setting where such modifications are not required by state or federal
law or by program-specific regulation. Such modifications must meet the requirements
for minor home modifications described in paragraph (3) of this subsection.
Costs for approved modifications made under this subparagraph are not included
in the calculation of the participant's lifetime allowance for minor home
modifications
. Such providers shall be reimbursed based on the lowest
bid obtained for the approved modification. If required, administrative fees
for coordination of modifications shall be based on the administrative fees
established by DHS for coordination of minor home modifications in the Community
Based Alternatives (CBA) Waiver program
;
(D)
child care-related transportation
that
[
(E)
(No change.)
(3)
Minor home modifications. The MDCP
reimburses
[
(A)
(No change.)
(B)
Bids from qualified contractors
are
[
(C)
All services
are
[
(D)
(No change.)
(E)
If alternative solutions exist,
DHS approves modifications
based on considerations of cost and comparable functionality
[
(F)
There
is
[
(G)
DHS
[
(H)
Expenses for minor home modifications, repairs and replacements
not covered by warranty, and related administrative fees
are
[
(4)
Adaptive aids. The MDCP
reimburses
[
(A)
(No change.)
(B)
The
[
(C)
(No change.)
(D)
Expenses for adaptive aids and related assessment, training,
and installation and administrative fees
are
[
(c)
(No change.)
§51.7.Cost Controls and Cost Savings.
(a)
If Medically Dependent Children Program (MDCP) expenditures
and budgetary considerations and constraints indicate that cost reduction
is necessary, the
Texas Department of Human Services (DHS)
[
(1)-(3)
(No change.)
(b)
Unspent appropriations to the waiver program
are
[
§51.31.Deinstitutionalization Due to Closure of Facility.
(a)
An individual who resided in a Texas nursing facility and
continued to reside there until scheduled to be discharged from the facility
due to its closure may apply for services to support the individual's deinstitutionalization
if the individual:
(1)
(No change.)
(2)
has met all of the criteria in of
§51.3(b)
[
(b)
The names of qualified individuals
who apply
[
(c)
An individual
who applies
[
(1)-(2)
(No change.)
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State on July 1, 2002.
TRD-200204150
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: August 11, 2002
For further information, please call: (512) 438-3734
40 TAC §51.6
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Department of Human Services or in the Texas Register office, Room
245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeal is proposed under the Human Resources
Code, Title 2, Chapters 22 and 32, which authorizes DHS to administer public
and medical assistance programs, and under Texas Government Code, §531.021,
which provides HHSC with the authority to administer federal medical assistance
funds.
The repeal implements the Human Resources Code, §§22.001-22.036
and §§32.001-32.052.
§51.6.Provider Base and Reimbursement Methodology.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed
with the Office of the Secretary of State on July 1, 2002.
TRD-200204151
Paul Leche
General Counsel, Legal Services
Texas Department of Human Services
Earliest possible date of adoption: August 11, 2002
For further information, please call: (512) 438-3734
Chapter 809.
CHILD CARE AND DEVELOPMENT
The Texas Workforce Commission (Commission) proposes amendments to §§809.92,
809.101, 809.103, and 809.121, relating to Child Care and Development rules.
The purpose of the proposed amendments to §809.92 and §809.121
is to move the reference in §809.92(b)(4) to §809.121. Since the
provision in §809.92(b)(4) applies more specifically to eligibility related
to children living at low incomes instead of the general eligibility requirements,
the Commission is proposing to relocate the provision.
In §809.101, the purpose of the amendments is to encourage the efficient
use of child care funds in support of families transitioning off of TANF by
removing specific references to education or training components and substituting
a broader reference to a "Choices activity" which includes work and employment-related
activities as well as education or training components. Additional clarifications
are made to update the terms consistent with the terms used in Chapter 811
related to Choices. The updates include changing the terms from "client" to
"recipient" and from "component" to "activity." Changes to subsection (d)
are made to emphasize that TANF recipients, whose temporary cash assistance
has expired must meet the requirements of Chapter 811 to receive transitional
child care. A statement is added to subsection (d) to clarify that this provision
does not apply to individuals engaged in unsubsidized employment who are eligible
under the provisions of §809.101(a)(1). Subsection (e) is added to state
that TANF recipients who are engaged in a Choices activity, meeting the requirements
of Chapter 811, and denied temporary cash assistance due to receipt of child
support, shall be eligible to receive transitional child care services until
the date on which the TANF recipient completes the activity, as defined by
the Board.
In §809.103, the purpose of the amendments is to clarify the intent
of the Commission, which is that Applicants who are employed at the time of
application, but continue to be eligible for temporary cash assistance, be
referred to a Workforce Orientation for Applicants and be eligible to receive
Applicant child care. The phrase "or retain" is added to subsection (a)(1),
and subsection (d) is added to clarify the Commission's intent to encourage
applicants who are working but continue to be eligible for temporary cash
assistance to obtain employment that will enable them to support their families.
The amendments emphasize the importance of full-time employment by limiting
Applicant child care services to 90 days for applicants who are employed less
than 15 hours a week at the time of application unless the hours of employment
are increased to a minimum of 30 hours per week before the end of the 90 days.
The rule also provides that Applicant child care may be extended to a total
of 12 months, inclusive of the 90 days, if the applicant increases the hours
of employment to at least 30 hours per week as required in §809.103(d).
Randy Townsend, Chief Financial Officer, has determined that for each year
of the first five years the rules will be in effect, the following statements
will apply:
There are no additional estimated costs to the state and to local governments
expected as a result of enforcing or administering the rules;
There are no estimated reductions in costs to the state and to local governments
as a result of enforcing or administering the rules;
There are no estimated losses or increases in revenue to the state or to
local governments as a result of enforcing or administering the rules;
There are no foreseeable implications relating to costs or revenue of the
state or local governments as a result of enforcing or administering the rules;
and
There are no anticipated economic costs to persons required to comply with
the rules.
Mr. Townsend has also determined that there is no anticipated adverse impact
on small businesses as a result of enforcing or administering the rules because
small businesses are not regulated by the rules and no requirements are placed
on small businesses by the rules.
James Barnes, Director of Labor Market Information, has determined that
there is no significant negative impact upon employment conditions in this
state as a result of the proposed rules.
Donna Garrett, Director of Child Care and Development, has determined that
for each year of the first five years the rules are in effect, the public
benefit anticipated as a result of enforcing the rules will be to set forth
the requirements for Choices child care to assist families with becoming self-sufficient.
Comments on the proposal may be submitted to John Moore, Acting General
Counsel, Texas Workforce Commission Building, 101 East 15th Street, Room 608,
Austin, Texas 78778, (512) 463-3041. Comments may also be submitted via fax
to (512) 463-2220 or e-mailed to: John.Moore@twc.state.tx.us. Comments must
be received by the Agency within 30 days from the date of the publication
in the
Texas Register
.
Subchapter F. GENERAL ELIGIBILITY FOR CHILD CARE
40 TAC §809.92
The amendments are proposed under Texas Labor Code §301.061
and §302.002, which provide the Texas Workforce Commission with the authority
to adopt, amend, or repeal such rules as it deems necessary for the effective
administration of Agency services and activities.
The amendments affect Texas Labor Code, Title 4, Texas Human Resources
Code Chapters 31 and 34, as well as Texas Government Code Chapter 2308.
§809.92.General Eligibility Requirements.
(a)
The eligibility criteria set forth in this chapter are
based primarily on the federal and state funding limitations. Nothing in this
chapter shall be applied in a manner that conflicts with those limitations
and the limitations contained in the use-of-funds provisions in the Commission's
child care allocation rule contained in Subchapter B of Chapter 800 of this
title (relating to Allocations and Funding).
(b)
For a child to be eligible for child care services, the
child's parents shall:
(1)
have a total gross income that does not exceed 85% of the
state median income for a family of the same size;
(2)
require child care to [
(3)
need the child care for a child under thirteen years of
age, unless a different age requirement is indicated in the applicable eligibility
rule contained in this chapter
.
[
[(4)
have met the Choices requirements as
specified in Chapter 811, or be determined by the Board to need child care
to comply with those requirements, if the child's parent is a TANF recipient
subject to those requirements.]
(c)
For purposes of this chapter, child care is needed to support
participation in education for a limited time as determined by the Board.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on June 26, 2002.
TRD-200204020
John Moore
Acting General Counsel
Texas Workforce Commission
Earliest possible date of adoption: August 11, 2002
For further information, please call: (512) 463-2573
serving
]
a limited number of children
. MDCP
[
that
] is approved
by the Secretary, Department of Health and Human Services, as authorized by
the Social Security Act, §1915(c). The MDCP focuses on both prevention
of nursing facility institutionalization and the deinstitutionalization of
children in those settings under 21 years of age through a thoughtful, collaborative
planning process and the prudent
use
[
utilization
] of
available resources. [
The
] MDCP depends upon involved parents and
informed professionals to provide the diverse perspectives and information
required to ensure the development of a satisfactory
Individual Plan
of Care (IPC)
[
individual plan of care
] for each participant
and the continued operation of [
the
] MDCP.
shall
] have the following meanings, unless the context clearly indicates
otherwise.
resulting
] in disability or loss of function. Adaptive aids enable people to
perform the activities of daily living or control the environment in which
they live.
he/she
] is next in line to fill a vacant position
in the waiver program, a vacancy exists, the
Texas Department of Human
Services (DHS)
[
Texas Department of Health (department)
]
has approved the filling of the vacancy,
DHS
[
the department
] has notified the individual, and the individual has submitted the
required application materials to
DHS
[
the department
]
within a specified time frame.
job-training
], or at school. Basic child care may be provided in a variety of settings,
including a licensed day care center, a registered family home, the child's
home, an after-school setting, or other usual child care setting. Basic child
care is a service that is separate and distinct from educational services
provided at a school where attendance is mandated and the primary focus of
the institution is the accomplishment of specified academic goals. Basic child
care is also separate and distinct from respite services
that
[
which
] are provided when the primary caregiver
normally
would
[
normally
] be available.
, which
] results in
the development of an Individual Plan of Care (IPC) and [
which
]
requires [
that
] the primary caregiver
to
pursue all
identified resources to be integrated into the IPC with authorized
Medically
Dependent Children Program (
MDCP
)
services.
(8)
] Child Care Management System
(CCMS)--A child care system administered by the Texas Workforce Commission
(TWC) that
[
which
] helps eligible parents by giving them
more choices in
child care
[
child-care
] arrangements
and by helping them find and pay for qualified caregivers
. Qualified
caregivers
[
, which
] may include
child care
[
child-care
] centers, registered family homes, or the child's grandparent,
aunt, or uncle.
TWC
[
The Texas Workforce Commission
]
establishes payment rates for CCMS-reimbursed child care services based on
data analyses of local market costs for child care services.
(9)
] Comprehensive child care--A
combination of basic child care, other support services mandated by state
or federal law, other required program-specific requirements, and approved
adjunct supports
that
[
which
] enable the [
Medically
Dependent Children Program (
] MDCP [
)
] participant to use
child care while the parent is at work, in
job training
[
job-training
], or at school.
(10)
] Cost allowance--The maximum
dollar amount available for reimbursement for a participant's approved waiver
services
. A cost allowance
[
, which
] is equal to 63%
of the annual amount assigned to the participant's Texas Index for Level of
Effort (TILE) designation for skilled nursing facility care as of September
1, 1996. The actual annual dollar amount approved for an individual participant
is less than or equal to the participant's cost allowance
.
[
,
]
This amount
is determined during the development of the
participant's
IPC
[
individual plan of care
], and is
based on factors
that include
[
including
] the participant's
assessed needs and the supports and other resources available to the child.
(11)
] Direct care--Hands-on care
for or supervision of a participant.
Respite and adjunct supports are
direct-care services reimbursable through MDCP.
[
Direct care services
reimbursable through MDCP are respite and adjunct supports.
]
(12)
Health Care Financing Administration
(HCFA)--An organizational division of the United States Department of Health
and Human Services that is responsible for approval, monitoring, and oversight
of state Medicaid programs.]
plan of care
] (IPC)--The instrument used to document the waiver and non-waiver services
available to a specific program participant during the specified period of
eligibility (typically [
,
] one year), the sources/providers of
those services, and the projected cost of the waiver services [
shown
on that document
]. The IPC is a separate document from the more detailed
documents
that
[
which
] may elaborate on its implementation.
(14)
] Minor home modification--A
physical modification to a participant's home, required by the participant's
IPC
that
[
, which
] is necessary to prevent institutionalization
or support deinstitutionalization.
(15)
] Participant--An individual
who has been determined eligible to receive waiver services and who receives
waiver services according to an IPC.
(16)
] Primary caregiver--An individual(s)
responsible
[
with the responsibility
] for a participant's
routine daily care and the provision of food, shelter, clothing, health care,
education, nurturing, and supervision. Primary caregivers may include but
are not limited to parents, foster parents, guardians, or other family members
by birth or marriage. A primary caregiver provides daily, uncompensated care
for the participant; does not delegate caregiving responsibilities to paid
providers a majority of the time; and participates in the development and
implementation of the MDCP participant's IPC.
Parents, primary caregivers,
and members of the participant's household cannot be paid as that participant's
provider(s) of MDCP services.
(17)
] Provider--An entity
that
[
which
] has an agreement with
DHS
[
the department
] to provide authorized waiver services for MDCP participants
for compensation according to approved IPCs.
(18)
] Qualified individual--An
individual who may be eligible to become an MDCP participant under the conditions
outlined in
§51.3(c)
[
§34.3(c)
] of this title
(relating to Participant Eligibility Criteria) for skilled nursing facility
deinstitutionalization.
(19)
] Registrant--An individual
whose name has been registered on the MDCP
interest
[
waiting
] list after
DHS
[
the department
] has received
his Interest List Information Form
[
his/her pre-application registration
materials
]. A registrant has requested a determination of
his
[
his/her
] eligibility in order to apply for waiver services.
(20)
] Respite--A service
that
[
which
] provides temporary relief from caregiving to
the primary caregiver of a waiver participant during times when the participant's
primary caregiver
normally
would [
normally
] provide
care.
(21)
] Service array--Home and community-based
Medicaid services available to MDCP participants by virtue of their waiver
eligibility.
(22)
] Texas Index for Level of
Effort (TILE)--The system used to quantify the intensity of the care needs
of individuals in Texas nursing facilities, and to assign daily reimbursement
rates for that care.
The Texas Board of Human Services establishes TILE
rates.
[
TILE rates are established by the Texas Board of Human
Services.
]
(23)
Waiting list--A statewide
listing of individuals ordered on a first-come, first-served basis who have
indicated their interest in participating in the MDCP through submission of
MDCP pre- application registration materials. Inclusion on the waiting list
does not imply eligibility for MDCP.]
HCFA
] under the Social Security
Act, §1915(c), authorizes the MDCP to waive certain Medicaid requirements
for the delivery of unique services to a specific population and to use unique
requirements for determining program eligibility. The term "waiver" may be
equated to "MDCP."
attesting
] that the authorized and other specified services are
necessary to avoid institutional placement and are appropriate to meet the
participant's needs in the home. The physician-approved
Individual Plan
of Care
[
individual plan of care
] (IPC) must specify health-related
care needs and must document waiver services, non-waiver Medicaid services,
and any other home and community- based services, as well as services and
supports provided by the primary caregiver(s);
which
] documents
the
Texas Department of Human Services' (DHS's)
[
Texas Department
of Health's (department's)
] plan to authorize and the participant's
plan to
use
[
utilize
] waiver services without an interruption
in service delivery of more than 60 days;
direct care
] waiver services (respite services and adjunct supports) for participants
who are age 20
is
[
will be
] prorated for the participant's
remaining eligibility period.
DHS
[
The department
] may
grant exceptions to the cost allowance for respite services or adjunct supports
on a temporary basis when extenuating circumstances preclude the development
or implementation of an IPC within the cost allowance. In such cases, approval
depends
[
will depend
] upon
DHS's
[
the department's
] review of the circumstances of the request; upon the availability
of other resources, including family, volunteer, or community resources; and
upon the waiver program's financial status.
DHS
[
The department
] may deny requests for exceptions to the annual cost allowance if vacancies
in the waiver are frozen, if the program anticipates a budgetary shortfall,
if the primary caregiver does not participate in identifying and pursuing
other possible resources
that
[
which
] must be used
before
[
prior to
] waiver services, or if the request does
not demonstrate that extenuating circumstances exist. A reduction in the annual
cost allowance does not in itself constitute an extenuating circumstance.
Following a review of the circumstances,
DHS
[
the department
]
determines
[
will determine
] which category of
exceptional funding is appropriate, as described in subparagraphs (A) and
(B) of this paragraph. The specific amount approved within a given category
is
[
will be
] based on a budget developed to address the extenuating
circumstances. Once approved, continuation of funding for each approved exception
to the cost allowance is subject to periodic review and renewal.
The department
]
may grant an exception to a participant's annual cost allowance not to exceed
10% of the participant's annual cost allowance if the existing extenuating
circumstances will likely be resolved within six months.
The department
]
may grant an exception to the participant's annual cost allowance under one
or more of the special circumstances described in clauses (i)-(iv) of this
subparagraph. The total amount allowable for exceptions under Category B may
not exceed $5,000. Special circumstances include:
which
] would make
child care in a group setting a life-threatening situation; and
foster care
] payment), and who is being cared for in:
which
]
is licensed or certified and supervised by PRS; or
which
]
is licensed or certified and supervised by a licensed public or private nonprofit
child-placing agency; or
which
]
receives full Medicaid benefits as a result of qualifying for
Temporary
Assistance for Needy Families
[
temporary assistance to needy families
] (TANF); or
Waiting
] lists. Participants
in the waiver program are selected from the MDCP
interest
[
waiting
] list, which is maintained on a first-come, first-served basis.
The names of Medicaid-eligible, qualified individuals who complete the MDCP
Interest List Information Form
[
pre-application registration process
] and who are residents of a Texas nursing facility as described in
subsection (c) of this section are maintained on a separate
interest
[
waiting
] list for nursing facility deinstitutionalization.
Their participation in the waiver
does
[
will
] not delay
the entry of individuals who are not residents of a Texas nursing facility
and whose names are maintained on the regular MDCP
interest
[
waiting
] list. A registrant's
interest
[
waiting
]
list status is assured unless:
pre-application
registration materials
] clearly
indicates
[
indicate
] the individual does not qualify as a candidate for the waiver program;
or
waiting
] list.
shall be
] closed. In such a case, the
registrant's name may be re-entered at the end of the
interest
[
waiting
] list, upon request. Exceptions may be made following
a review of special circumstances.
shall be
] denied or terminated if:
utilized
] as described in the IPC, unless:
applicant/participant's
] primary caregiver fails to return a signed IPC within the specified
time frame, not to exceed 30 days from transmittal of the unsigned document;
applicant/participant's
] primary caregiver does not participate in the eligibility determination
process, the care planning process, or the implementation of the IPC;
applicant/participant's
] primary caregiver does not comply with the responsibilities enumerated
in a departmental form
that he
[
which he/she
] has signed;
or
§34.5(b)(1)
] of this title (relating
to Waiver Services) for MDCP respite services; or
plans of care
] (IPCs) must include services provided by parents and/or primary caregivers;
non-waiver services; and waiver services.
will be
] coordinated
with other available resources, including Medicaid state plan services.
will be
]
responsible for the cost of basic child care.
will be
] calculated based on:
e.g.
], those developed and
used
[
utilized
] by the Child Care Management System (CCMS)
of the Texas Workforce Commission.
for
] the resources of the CCMS; or
which
] provide skilled nursing services; licensed HCSSAs
that
[
which
] provide personal assistance services with and/or without
delegation by
an RN
[
a registered nurse
]; independently
enrolled attendants who meet program participation standards as approved by
the
CMS
[
Health Care Financing Administration (HCFA)
];
host families who meet the requirements for foster homes or who meet other
program participation standards as approved by
CMS
[
HCFA;
camps accredited by the American Camping Association
]; licensed child
care facilities
that
[
which
] meet state requirements
for
respite-care
[
respite care
] providers; licensed
special-care
[
special care
] facilities; licensed nursing
facilities; [
and
] licensed hospitals
; and camps accredited
by the American Camping Association. For accredited camps, reimbursement rates
shall be based on those adopted by the Texas Department of Health (DHS) for
the Community Living Assistance and Support Services (CLASS) Waiver program
. Providers must operate within the scope of their licensure, accreditation,
participation standards, or other applicable regulations.
will be
] approved only for those hours when the primary caregiver is working,
attending job training, or attending school. Adjunct supports may include,
but are not limited to, the following:
which
] is not required of the child care provider by state or federal
law or by program-specific regulation, or which is not otherwise available
in the community
. Providers of child care-related transportation shall
be reimbursed based upon the lesser of their established fees and the established
Medicaid reimbursement rate for a comparable service/provider
; and
will reimburse
] qualified providers the cost of approved minor
home modifications that are necessary to prevent the institutionalization
or support the deinstitutionalization of an applicant/participant.
For
minor home modifications, reimbursement rates shall be based on the lowest
of the comparable and responsible bids submitted for the approved modification.
Administrative fees shall be based on those adopted by DHS for the CBA Waiver
program.
shall
be
] required.
shall be
] provided
in accordance with applicable state and local building codes.
modifications will be approved by the Texas Department of Health (department)
based on considerations of cost and comparable functionality
]. If more
than one option is available,
DHS
[
the department
]
approves
[
will approve
] the amount equivalent to the least
costly option of comparable functionality. If the caregiver/participant selects
a more costly option, the caregiver/participant
is
[
shall
be
] responsible for any costs
that
[
which
] exceed
those approved by
DHS
[
the department
].
will be
] a maximum lifetime
allowance of $7,500 for approved minor home modifications. In addition, up
to $300 per year
is
[
will be
] available for repair or
replacement of these minor home modifications when such repair or replacement
is not covered by warranty. The lifetime allowance is based on the participant's
lifetime.
The department
] may establish
an administrative fee for local agency coordination of these services.
will be
] budgeted within the participant's annual cost allowance.
will
reimburse
] qualified providers the cost of approved adaptive aids that
are necessary to prevent the institutionalization or support the deinstitutionalization
of an applicant/participant, that are related to the applicant's/participant's
disability, and that have a manufacturer's suggested retail price of $100
or more.
Reimbursement rates shall be based on the manufacturer's suggested
retail price minus the weighted average percentage discount as authorized
by the Texas Medicaid State Plan for providers of durable medical equipment.
If the manufacturer does not offer a discount to the provider, the reimbursement
rate will be the provider's cost plus a percentage, as authorized by the Texas
Medicaid State Plan for providers of durable medical equipment. If bids are
required, the reimbursement rate shall be based on the lowest bid obtained
for the approved adaptive aid.
There will be a
] maximum annual
allowance [
of $4,000
] for approved adaptive aids
is $4,000
. A portion of this amount may be used to support assessment, training,
and installation related to the adaptive aids.
will be
]
budgeted within the participant's annual spending allowance for adaptive aids
and within the participant's annual cost allowance.
Texas Department of Health (department)
] may implement measures to reduce
costs. Medicaid eligibility for waiver participants
is
[
shall
] not [
be
] affected in such circumstances. Cost reduction
measures may include, but are not limited to:
shall be
] reinvested directly or indirectly into the waiver program
to the extent allowable by state law and departmental rule and policy.
§34.3(b)
] of this title (relating to Participant Eligibility
Criteria).
applying
] for nursing facility deinstitutionalization under the
Medically Dependent Children Program (MDCP)
are
[
shall be
] maintained on
an interest
[
a waiting
] list separate
from that for other MDCP registrants.
applying
]
for nursing facility deinstitutionalization under MDCP
becomes
[
shall become
] eligible for waiver services under this subsection
if:
Part 20.
TEXAS WORKFORCE COMMISSION
work or
] participate
in training
,
[
or
] education
, or employment
activities;
and
; and
]
Subchapter G. CHILD CARE FOR PEOPLE TRANSITIONING OFF PUBLIC ASSISTANCE